Background

A hordeolum (ie, stye) is a localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes (ie, external hordeolum) or meibomian glands (ie, internal hordeolum).

A hordeolum usually is painful, erythematous, and localized. It may produce edema of the entire lid. Purulent material exudes from the eyelash line in external hordeola, while internal hordeola suppurate on the conjunctival surface of eyelid.

A chalazion is a painless granuloma of the meibomian glands. The two entities may be distinguished based on the presence or absence of pain. The remainder of this article focuses on hordeolum.

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Pathophysiology

Staphylococcus aureus is the infectious agent in 90-95% of cases of hordeolum.

An external hordeolum arises from a blockage and infection of Zeiss or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis.

Untreated, the disease may spontaneously resolve or it may progress to chronic granulation with formation of a painless mass known as a chalazion. Chalazia can be quite large and can cause visual disturbance by deforming the cornea. Generalized cellulitis of the eyelid may occur if an internal hordeolum is untreated.

Most morbidity is secondary to improper drainage. Proper technique and drainage precautions are described in Treatment.

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Epidemiology

Frequency

United States

Exact incidence of the disease is unknown, but it is a common entity.

International

No difference exists between US and international occurrence.

Sex

No sexual predilection exists.

Age

A slight increase in incidence is observed in the third to fifth decades of life.

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Prognosis

Spontaneous healing is common.

Frequent recurrences are common.

Progression to systemic infection is rare; only a few case reports appear in the current literature.

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Patient Education

Instruct patients on proper use of warm compresses and antibiotic use as described above.

For prevention, educate patients about lid hygiene.

Instruct patients not to squeeze a stye, because infection may spread to adjacent tissues.